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Preparing for Ebola in St. Louis Could Cost Millions, Health Department Director Says

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After test results confirmed that a nurse in Dallas had contracted the deadly Ebola virus from a patient, the head of the Centers for Disease Control and Prevention told hospitals to ‘start thinking Ebola’ when patients present flu-like symptoms.

Hospital officials in the St. Louis region say they’ve already done so. They've been working to determine protocols, train health workers and buy protective equipment. The virus is transmitted through direct contact with bodily fluids.

If a patient with Ebola arrives in a St. Louis emergency room, the response will be coordinated among multiple public health agencies, area hospitals and the CDC, according to Pam Walker, Director of the St. Louis Health Department.

“We perform the contact investigation to make sure we find anyone who’s exposed. We make decisions about isolation and quarantine orders. We make sure supportive services are in place for anyone who’s in quarantine. And we conduct active surveillance to see if any cases are showing up within the region,” Walker said.

Walker said if the St. Louis region is going to be prepared, public health entities will need up to $10 million in funding. But at this time, her agency is not receiving general revenue funds from the state health department. 

“It is costly and our infrastructure has been cut over the past 10 years. I think this is going to bring that to light nationwide, but particularly here in Missouri,” Walker said.

Governor Jay Nixon withheld $3.3 million in funding for Missouri's public health departments after the General Assembly failed to pass a balanced budget.

Walker said she’s appealing to the state to release those funds, particularly now that Ebola cases have been confirmed in the U.S.

Hospitals have also determined internal protocols for suspected cases of Ebola.

Dr. Shephali Wulf, an infectious disease specialist with SSM Health Care, said triage nurses have been trained to ask people with flu-like symptoms if they have traveled or had contact with anyone who has traveled to Sierra Leone, Guinea or Liberia in the past 21 days.

“If the answer is 'yes,' then that patient is automatically placed in an isolation room, in a private room with their own bathroom,” Wulf said. “Anyone entering the room will have to wear a gown, gloves, a face mask and eye protection.”

A program built into the hospital’s computer system will then notify the lab to expect blood samples for testing, and it will alert infectious disease and infection control specialists within the network.

Should an individual be diagnosed with Ebola, Wulf said hospitals in the SSM Health Care network have chosen to place patients in negative pressure rooms, not because negative pressure would be needed but because the two-room design facilitates a separate room for health workers to put on and remove protective gear.

“Every hospital has these rooms,” Wulf said. “St. Joseph’s Health Center (in St. Charles) has a handful of them.”

She added that most hospitals already have the necessary gear to protect staff from a patient’s bodily fluids. Workers have been trained in necessary protocols for taking equipment on and off, and Wulf hopes to implement a buddy system to ensure it’s done in the right manner. But, Wulf said, there is still a risk of transmission.

“These are areas where hospitals in general struggle. There are many hospitals that struggle with hand hygiene, and wearing protective equipment on a daily basis, and with an Ebola patient there is really no room for error.”

Wulf said nurses, such as the young woman who fell ill in Dallas, would be at the highest risk for contracting Ebola from a patient.

“Our nurses spend the most time with sick patients. They’re the ones that are responsible for cleanup of bodily fluid,” Wulf said. “There is a lot of fear among the staff, which I think is legitimate.”